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The Federal EPSDT Program Created in 1967 during Johnson Administration –to discover, as early as possible, the ills that handicap our children and – to provide continuing follow up and treatment so that handicaps do not go neglected. For Medicaid enrolled children birth to age 21 Provides access to a broader range of services than may otherwise be covered by a states Medicaid program

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The Two Parts of EPSDT Part 1: Access or Administrative Informing the family of the benefits of prevention and the health services and assistance available Providing assistance with finding a provider and scheduling an appointment Arranging for transportation and interpreters Following up on referrals and provide linkages to other agencies and services Sources: Center for Medicare and Medicaid Services, State Manual Part 5 EPSDT.

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The Two Parts of EPSDT Part 2: Screenings and Services Assess the childs health needs through initial and periodic examinations and evaluation to assure that health problems found are diagnosed and treated early, before they become more complex and their treatment more costly. Provide for assessment and treatment of problems identified to correct or ameliorate the condition Sources: Center for Medicare and Medicaid Services, State Manual Part 5 EPSDT.

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Periodicity Schedule Flexibility States have the flexibility to chose their periodicity schedule: the frequency of recommended preventive health care visits Minnesotas schedule has 20 visits from birth to age 21 Informal survey in 2006: 39 states had more visits than Minnesota, 2 had less, 9 were the same Number of visits ranged from 15-30 from birth to age 21 2005 Deficit Reduction Act provided additional flexibility for benchmark benefit sets

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Components of an EPSDT Visit Comprehensive health and developmental history, including mental and physical development Comprehensive physical examination Immunizations and laboratory tests, including blood lead Vision and hearing screening Dental screening and referral Health education and anticipatory guidance Diagnosis and treatment services as medically necessary

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…is a set of principles, strategies and tools that are theory - based, evidence - driven, and systems - oriented, that can be used to improve the health and well-being of all children through culturally appropriate interventions that address the current and emerging health promotion needs at the family, clinical practice, community, health system and policy levels.

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Health and wellbeing of children and families Access to health and dental care Disparities Performance Measures Public Health Priorities

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Bright Futures and Title V Use Bright Futures as a guide to develop policies and programs to improve quality of childrens health care and health outcomes. Use Bright Futures as common standard for clinical care. Use materials to help parents and youth get prepared and make the most of every visit. Use the anticipatory guidance sections for education of community partners other child health professionals and parents directly.

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Bright Futures and Title V Consider using Bright Futures themes in agency/community education activities. Use strength-based approaches and shared decision making strategies to engage with community partners and parents.

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Documentation of great care New office systems approaches Ready for recertification and pay for performance Improved access to community resources Knowledge of latest best practice/materials Network of committed professionals/learn Potential For Public Health Clinics and Practices

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Provide information about the content tools (how to order) or download Referral resources Public health data Provide training and support for office systems change (data from parents) Public Health a Key Partner

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National Center for Cultural Competence Review of Bright Futures Literacy (lack of education) How do they prefer to receive information? (access to information) Language spoken at home Family structure, who lives in the home, and supports (lack of family resources, family disintegration) Sources of advice (media, marketing to children)

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Parental expectations: childrearing beliefs, health beliefs Home environment (displacement, homelessness) Community environment (access to play, neighborhood safety) Establishing trust Do you see anyone else about the health of your child or family? National Center for Cultural Competence Review of Bright Futures

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Improvement Partnership …a durable, regional collaboration of public and private partners that uses measurement-based efforts and a systems approach to improve the quality of childrens health care.

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are customized according to the characteristics of each state or region IPs are developing in different ways with a variety of partners. Some are housed at academic medical centers, state of local health departments or state chapters of the American Academy of Pediatrics Improvement Partnerships

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Why MN Established an Improvement Partnership Growing interest from providers in quality improvement activities, some larger clinic systems creating their own Not a strong state AAP Chapter, no learning activities Occasional cost-saving projects from a health plan quality improvement consortium, focused on adults No existing structure focused on quality improvement for children

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Spring 2007 - An Opportunity Minnesota Chapter of the American Academy of Pediatrics (MN- AAP) application for funding from Commonwealth Fund for a technical assistance grant provide by VCHIP to develop a permanent entity in the state Leadership Partners: –Minnesota Department of Human Services –Minnesota Department of Health

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Healthy Development through Primary Care Project Goal: increase the use of standardized developmental, mental health and maternal depression screening tools into pediatric primary care clinic visits 9 practice teams from around the state, each team includes at least: a pediatric primary care provider, nurse and third individual determined by the team 1 ½ - 2 year project, learning collaborative kick-off mtg. November 9, 2007 and a second learning collaborative session on January 15, 2009

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Project Activities for Participating Teams Participate in learning collaborative session Meet as a team twice a month Participate in a monthly telephone conference with other teams and project staff Collect family surveys to measure satisfaction Gather data from medical records to measure screening rate